Research in the Clinical Journal of the American Society of Nephrology shows that with the help of Medicaid expansion under the Affordable Care Act, many low-income patients with CKD were placed on the kidney transplant waiting list before starting dialysis. Additionally, the expansion was associated with an increase in the proportion of new preemptive listings for kidney transplantation with Medicaid coverage, with larger increases in coverage for racial and ethnic minority listings than white listings.
Meera N. Harhay
“Our findings suggest that Medicaid expansion provided a path to transplantation for many low-income U.S. individuals with kidney disease,” Meera N. Harhay, MD, MSCE, lead author and assistant professor of medicine at Drexel University College of Medicine, told Healio Nephrology. “On the other side, our study highlights the concern that many other low-income individuals with kidney disease in the U.S. may not be provided similar opportunities as a consequence of Medicaid non-expansion or future policies that restrict Medicaid coverage.”
Harhay and colleagues wrote: “From the pre- to post-expansion period, the adjusted proportion of listings with Medicaid coverage decreased by 0.3 percentage-points among non-expansion states and increased by 3 percentage-points among expansion states.” Furthermore, they found the expansion was associated with an absolute increase in Medicaid coverage by 1.4 percentage-points among white listings. Expansion was linked with an absolute increase in coverage by 4 percentage-points among black listings, by 5.9 percentage-points among Hispanic listings and by 5.3 percentage-points among other listings.
Investigators used the United Network of Organ Sharing database to perform a retrospective observation study of adults listed for kidney transplantation before starting dialysis between Jan. 1, 2011 and Dec. 31, 2016. They used multinomial logistic regression models to compare trends in insurance types used for preemptive wait-listing in states that expanded Medicaid vs. states that did not expand the program.
“In our study, we found that after states expanded Medicaid, Medicaid-beneficiaries started to make up a larger proportion of new preemptive listings for kidney transplantation,” Harhay said. “Also, compared to Medicaid-covered listings from non-expansion states, expansion states Medicaid-covered listings were more likely to be employed and functionally independent.”
Medicaid expansion was associated with an increase in the proportion of new preemptive listings for kidney transplantation with Medicaid coverage, with larger increases in coverage for racial and ethnic minority listings than white listings.
Specifically, states that fully implemented Medicaid expansion had a 59% relative increase in Medicaid-covered preemptive listings compared to an 8.8% relative increase among the 19 states that did not expand the program.
“States have made divergent choices about whether to expand Medicaid under the Affordable Care Act to cover more low-income individuals,” Harhay told Healio Nephrology. “These different choices may have profound implications for the care for low-income individuals with kidney disease.” – by Jake Scott
The authors report no relevant financial disclosures.